A 35-year-old female is hospitalized with headaches and vomiting. She has a long history of psychiatric illness and is known to practice eccentric dietary habits. Physical findings include papilledema, dry skin and hepatosplenomegaly. Head CT scan is ordered immediately but is negative for intracranial mass. Which of the following is a likely cause of this patient's condition?

Question

A 35-year-old female is hospitalized with headaches and vomiting.  She has a long history of psychiatric illness and is known to practice eccentric dietary habits.  Physical findings include papilledema, dry skin and hepatosplenomegaly.  Head CT scan is ordered immediately but is negative for intracranial mass.  Which of the following is a likely cause of this patient's condition?

Quizplus · Accepted Answer

Individuals who consume more than 10 times the Daily Value (Recommended Dietary Allowance) of vitamin A are prone to developing toxicity and may suffer hepatic injury so severe as to cause cirrhosis. Vitamin A toxicity has been subdivided into three syndromes: acute, chronic, and teratogenic. The signs and symptoms of acute toxicity occur after the ingestion of a single high dose of vitamin A and include nausea, vomiting, vertigo, and blurred vision. The signs and symptoms of chronic toxicity occur after the long-term ingestion of high doses of vitamin A, and include alopecia, dry skin, hyperlipidemia, hepatotoxicity, hepatosplenomegaly, and visual difficulties. Papilledema, when present, is suggestive of cerebral edema in the setting of benign intracranial hypertension (pseudotumor cerebri). Teratogenic effects of excessive vitamin A ingestion include microcephaly, cardiac anomalies, and fetal death (especially in the first trimester of pregnancy). (Choice A) Thiamine deficiency is associated with infantile and adult beriberi, as well as Wernicke-Korsakoff syndrome in patients with alcohol use disorder. (Choice B) Niacin deficiency is characterized by the 3 D's of pellagra: (dementia, dermatitis, and diarrhea). (Choice C) Vitamin B₁₂ (cobalamin) deficiency is frequently associated with pernicious anemia. The classic presentation of pernicious anemia is an older, mentally slow woman of northern European descent who is "lemon colored" (anemic and icteric), has a smooth, shiny tongue indicative of atrophic glossitis, and demonstrates a shuffling broad-based gait. (Choice D) Vitamin B2 (riboflavin) deficiency is characterized by cheilosis, stomatitis, glossitis, dermatitis, corneal vascularization, and ariboflavinosis. (Choice E) Large doses of vitamin C can give false negative stool guaiac results and are associated with diarrhea and abdominal bloating. Some studies suggest an association between high doses of vitamin C and calcium oxalate nephrolithiasis, though this remains controversial. (Choice F) Large doses of vitamin E have been associated with higher mortality rates due to hemorrhagic stroke in adults and higher rates of necrotizing enterocolitis in infants. Educational objective: Vitamin A overuse can result in intracranial hypertension, skin changes and hepatosplenomegaly.

A 35-Year-Old Female Is Hospitalized with Headaches and Vomiting